Since 1973, the Workshop for Institute Representatives has focused on the topic of the “problem candidate”, especially the factors that lead to a candidate resigning or failing to complete his training. It has been found in these discussions that this topic involves every aspect of the functioning of the institute, including the selection process, the training analysis, the philosophical approach to a candidate analysis as distinguished from a therapeutic analysis, the supervisory experience, problems related to progression, leave of absence, interruption of the analysis, transfer from one training analyst to another or from one supervisor to another, resignation by the candidate or termination of the candidate's training status by the institute. Discussion covered the multitude of factors that are considered in the promotion, graduation, or termination of a candidate's training status, and the relationship of the institute and society with the candidate following the interruption of training. Studies by Drs. Sidney Levin, Joseph J. Michaels, Daniel Shapiro, Kato Van Leeuen, and reports of workshops by Drs. Joan Fleming, John F. Kelly, L. B. Hall, James Raney, and Earle Baughman were used as bases for the discussions.
In all the studies and discussions a most impressive fact has been that the incidence of dropouts is very high in almost all the institutes. This occurs in spite of the fact that all institutes have had rather extensive selection procedures, have given some years of trial periods, and have made very careful reviews of the candidates' work by various committees from the earliest period in their training. Termination is most painful for the trainers and may be disruptive for the trainee. Humiliation suffered by the terminated candidate is severe, and it is surprising how often the experience is unexpected by the candidate, even though he has been warned both verbally and in written form on many occasions before the actual interruption of his training occurs. Decisions concerning termination are almost always extremely difficult to reach, usually made only after long periods of deliberation and after the candidate has spent several years in the institute, sometimes reaching a fairly advanced stage in his training.
It was noted that all institutes resort to what is called “compassionate” graduation at rather frequent intervals. No guidelines exist for such a procedure. On many occasions, however, such graduation has been valuable for both the individual and for the profession. Many times it is found that a troubled candidate who is being considered for termination, when given additional supervision and experience, seems to work out and become quite successful. A problem often developing is a polarization in the institute with some members of the education committee being lenient, while others are much more strict. Often the recommendation for termination will thus depend on the orientation of the supervisors. In general, assignment of analysts and supervisors, as is done in some institutes, does not seem to be more successful than permitting the candidate to choose his analyst and supervisor on his own.
It was observed that the candidate who has a problem in getting the analysis of the first case started, even though this is often attributed to the difficulty of the case by both the candidate and the supervisor, often proves to be a candidate with problems that will prevent his completion of training. No statistical studies have been done on this. Although the procedure of having the candidate start with two patients quite close together with different supervisors seems to be more helpful in prediction than in having him start one, it was generally agreed by the group that this procedure may not be fair to the patients.
Attempts to use the personal analysis as supervisory sessions, and vice-versa, tend to interfere with the training, the personal analytic experience, and to diffuse the transference and possibly introduce counter-transference difficulties. Surprisingly enough, most institutes feel that rarely is a mistake made by dropping a problem candidate. The error is usually in the other direction. Here again, this has not been studied in depth, and seems to be based on impressions more than on actual data. Supervisory reports are more valuable than class reports; tutorial techniques in some instances have been helpful, and seem to deserve a trial in institutes which have not yet tried such a system. The flexible procedure in current use probably should be continued, but more studies should be done by the institutes on the effectiveness of each particular system, and the results communicated to the American.
In regard to a tutorial arrangement, questions were raised at the Workshop as to whether this intensive approach may tend to circumvent the basic pathology of the problem candidate by preempting his capabilities for working through his conflicts in his training analysis, and preventing him from developing his capacities as an analyst in a more independent manner. Also, note was made as to how so much close control and overseeing would change the character of the institute. It was also mentioned how often problem candidates seem so bored with their analytic work, or present their material in a boring fashion. This phenomenon could be prognostic, since it frequently suggests the student might have difficulties with empathy or an inability to get close to the analytic process.
There were lengthy discussions on the problem of reporting by the training analyst. The attitude of the candidate about reporting often is based on personal reasons or the philosophy of his teachers; however, it is generally accepted that since the training analyst is a member of the educational institution, there is a built-in distortion of the analytic situation. For this reason, many analysts feel involvement by training analysts should be kept to an absolute minimum. There is the view that when a gross error is being made by the institute in its evaluation of a candidate, the analyst should step in and report, even though it may not be the usual procedure in that particular institute. Examples of the prevention of serious errors were given by discussants. The group agreed that all these issues need a great deal more study, and there was no consensus about this particular question.
Success or failure is extremely difficult to predict. In general, people who fail have been enrolled in institutes for many years, have had supervision in varying numbers of cases, and for the most part were terminated by the institute, although this could not be easily determined in most of the studies because many times the individual was offered the opportunity to resign. The reasons for termination were not clear. Institutes listed most often characteristics such as excessive compulsiveness, transference problems, severe pathology, excessive narcissism, and deficiencies in the capacity for empathy. A finding that seems to be confirmed generally is that letters of recommendation of a negative nature are more reliable than positive ones, and evaluations by peers seem to be more accurate than by teachers and supervisors. Another finding from the group's discussion was that clashes with a member of the faculty, especially if that faculty member is influential in the institute, may often get a candidate into trouble from which he cannot recover. When this occurs, a candidate is often dropped by the institute.
How much the supervisors or advisors should discuss with the candidate the opinions of his teachers about his work and his problems was a matter of great discussion in the group, for there was concern about such discussion interfering with the candidate's analysis. There was agreement that when discussion is needed, it should be done by one person, should be as clear as possible and documented, so that the candidate can, in his analysis, distinguish what he has heard from his teacher, and what is involved in his analysis.
There is an obvious need for some kind of evaluation of training analysts, especially one who seems to be recurrently involved with problem candidates. This is an extremely complex problem involving issues such as friendships, unresolved transference and counter-transference issues, physical or mental disabilities, and differences in philosophy or scientific understanding.
In the context of trying to clarify what it means for the training analysis that the analyst and candidate may have an ongoing relationship as colleagues following the termination, the suggestion was made that termination of a training analysis is similar to an adolescent's working through his ambivalence, idealizations, and increasing sense of individuality to the point where he can be “friends” with his parents. Aside from the emotional growth of the adolescent, this outcome presumes that the parents have the emotional maturity to reciprocate, and allow a sense of equality to develop. This concept opens up a large area for further study and discussion, and may help explain one source of difficulty in some training analyses.
The question of “objectification” of the analysis as suggested by Drs. Kelly, Fleming, and Hall of Denver provoked a great deal of discussion. Opinion ranged from the necessity of including it in the technical approach to the analysand, to the view that the average analysand would not need to deal with this in any more of a special manner than the ordinary patient. Discussion of “objectifying” what the analytic experience is like, revolved around concerns over a possible intellectualization of the analysis.
From the discussion of the past several years the workshop would like to present to psychoanalytic educators and institutes the following questions and recommendations:
How can evaluation procedures be improved?
Is there any resolution to the problem of reporting by the training analyst? Often the report is of little value because of the training analyst's unconscious involvement with the candidate. With this arrangement, is there a danger of the analyst being predisposed to taking sides, and toward counter-transference attitudes?
What factors should go into the decision to grant a compassionate graduation, which seems to be procedure used (and will continue to be used, since it has value for the profession) by almost all institutes?
Should the institute decide that the candidate change personal analyst, advisor, or supervisor? If so, what means should be used?
When polarization occurs in an institute, how should it be resolved? Should consultants from outside be used, or should some other resource be sought?
Should analysis be encouraged by institutes after graduation when it is obvious that unresolved problems, which may interfere with the graduate's work, exist?
Should the tutorial system be instituted as a regular procedure for institutes?
A national study seems necessary because of the variation in procedures in different institutes. This would help determine whether institutes should be more consistent than they are at the present time.
Should a training analyst's work be evaluated at intervals, especially if his candidates seem to have more trouble than others? How often should this be done? How can it be communicated to the training analyst in the least traumatic way?
Have we failed to consider the special characteristics of the training analysis, as has been suggested in its comparison with the adolescent transference, that can be recognied in our general practice?
The American should make some provision for a type of affiliate membership with continued recognition by and association with the American Psychoanalytic Association, for those candidates who did not complete their training, yet who are capable psychiatrists and productive members of the profession interested in and familiar with psychoanalytic concepts and various aspects of psychoanalytic techniques.
It is the policy of this Workshop to elect a new chairman every two or three years. In the period of this report, the Workshop was chaired by Dr. Sidney Levin of Boston, and by Dr. John J. Francis of the Baltimore-D.C. Institute. Dr. Irwin H. Marill of the Baltimore-D.C. Institute will begin his term of office in December of 1977.
John J. Francis
Irwin H. Marill